IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA ) Plaintiff(s) ) ) vs. ) Case No. ) ) Defendant(s) PART 1: JOINT C ONSENT TO JURISDICTION BY UNITED STATES MAGISTRATE JUDGE (USE ONLY IF ALL PARTIES CONSENT) In accordance with the provisions of Section 636(c)(1) of Title 28, United States Code , we voluntarily consent to have a United States Magistrate Judge conduct any and all further proceedings in the case, including trial and entry of a final judgment, with direct review by the United States Court of Appeals for the Third Circuit i f an appeal is filed. Date: Counsel for Plaintiff(s) Plaintiff(s) Print Name: Date: Counsel for Defendant(s) Defendant(s) Print Name: Date: Counsel for Defendant(s) Defendant(s) Print Name: --------------------------------------------------------------------------------------------------------------------- PART 2 : DISTRICT JUDGE OPTION Pursuant to Section 636(c)(2) of Title 28, United States Code, w e acknowledge the availability of a U nited States Magistrate Judge but we elect to have this case randomly assigned to a United States District Judge. Date: Counsel for Plaintiff(s) Plaintiff(s) Print Name: Date: Counsel for Defendant(s) Defendant(s) Pri nt Name: Date: Counsel for Defendant(s) Defendant(s) Print Name: Rev. 06/16 American LegalNet, Inc. www.FormsWorkFlow.com